Get Tx Residency Verification Form 2010-2026

The TX Residency Verification Form is a vital document used to verify residency and experience in orthotics and prosthetics. This guide provides clear and detailed instructions on how to complete the form online, ensuring accuracy and compliance with requirements.

Follow the steps to fill out your TX Residency Verification Form online.

1. Click ‘Get Form’ button to access the TX Residency Verification Form and open it for completion.
2. Begin by entering the applicant's name in the designated field. Ensure that it matches the name used in official identification.
3. Provide the applicant's address, including street number, city, state, and zip code. Double-check the information for accuracy.
4. In the certification section, a person who can verify the applicant's experience must fill in their name. This individual should be familiar with the applicant’s work.
5. The certifier must indicate their relationship to the applicant by stating their title or role, such as employer.
6. Record the employment duration by filling in the start and end dates of employment. Ensure that the format is consistent with the MM/DD/YYYY format.
7. List the name of the facility and its license number where the residency experience was obtained. This information should be accurate and up to date.
8. Select the type of facility where the work was performed by ticking the appropriate box: Orthotic Facility, Prosthetic Facility, Orthotic/Prosthetic Facility, or Other.
9. On the specified date, the certifier must endorse the form with their signature, confirming that the information provided is true and correct.
10. Finally, submit the document for notarization if required. A notary will need to sign and place their seal for the document to be valid.
11. Users can then save the completed form, download it for future reference, print a copy for their records, or share the document as needed.

Complete your TX Residency Verification Form online today to ensure your residency is accurately verified.